The primary purpose of study is the collection of feasibility data for a larger trial of Structural Integration (SI)(an alternative manual therapy) for chronic low back pain. The secondary purpose is the collection of preliminary data on 1) the therapeutic effect of SI plus usual care versus usual care alone - the hypothesis being the the effect size will be significantly greater in the SI plus usual care arm; and on 2) specific hypothesized mechanisms of that hypothesized therapeutic effect: a) improvements in cognitive behavioral factors; b) improvements in standing balance and gait, and c) improvements in selected blood biomarkers.

Each subject in this arm will receive ten Structural Integration treatments at intervals of between one and three weeks, and will also receive usual care for chronic low back pain as standard practice at Spaulding Medford Rehabilitation Clinic, which may include pain medication, exercise and physical therapy. Usual care will be provided on average twice weekly for between 3 and 7 weeks, at the discretion of the clinic's medical director

Procedure: Structural Integration

Structural Integration (SI) is an alternative method of manual therapy and somato-sensory training that purports to improve biomechanical functioning of the body as a whole rather than to focus on the treatment of specific symptoms. SI therapists employ both manipulation and somatosensory education. SI is delivered in a series of ten treatments, referred to as "the Ten Series," each of approximately one hour in duration. The Ten Series protocol includes manipulation of all major joints and anatomical segments. Each of the ten sessions aims to achieve a different set of biomechanical changes, which are regarded as contributing to the progressive approximation of specific ideals of posture and movement.

Other Name: Rolfing, a registered service mark of the Rolf Institute

Procedure: Usual care

Usual care in this study consists of the treatment regimen provided for chronic low back pain at Spaulding Medford Rehabilitation clinic, which may include pain medication, exercise and physical therapy. Frequency of treatment averages twice weekly, duration ranges from 3 to 7 weeks

Other Name: Standard care

Active Comparator: Usual care

Each subject in this arm will receive care for chronic low back pain as standard practice at Spaulding Medford Rehabilitation Clinic, which may include pain medication, exercise and physical therapy. Usual care will be provided on average twice weekly for between 3 and 7 weeks, at the discretion of the clinic's medical director

Procedure: Usual care

Usual care in this study consists of the treatment regimen provided for chronic low back pain at Spaulding Medford Rehabilitation clinic, which may include pain medication, exercise and physical therapy. Frequency of treatment averages twice weekly, duration ranges from 3 to 7 weeks

Chronic low back pain patient-rated >=3 on a VAS (0-10) with retrospective duration of at least 6 months

Low back pain attributed to mechanical as opposed to infectious, neoplastic or inflammatory causes

Age 18-65

English speaking

Male or female

Mental capacity sufficient to provide informed consent

Able to commit to up to 27 study meetings over a period of 5 months.

Exclusion Criteria:

Impairment of hearing, speech, vision, mobility or English fluency sufficient to interfere with participation in the study

Current or anticipated receipt of payments from Workmen's Compensation or other insurance for disability attributed to low back pain.

Reports any prior treatment with Structural Integration (Rolf or other varieties, including "structural massage")

Plans to initiate additional treatment for back pain during the period of the study other than usual rehabilitation care provided at Spaulding Medford clinic, particularly massage or other manual therapy (e.g. chiropractic, osteopathic)

Unresolved musculoskeletal pathology of the lower limbs

Pregnancy

Clinical judgment by Spaulding Medford medical director that the candidate will require either surgery or epidural analgesia within the next five months.

Alcohol of substance abuse

Any implanted medical device (e.g. cardio-pacemaker, shunts)

Prior discectomy or implantation of rods, screws or plates (bulging disc without radicular pain is not exclusionary; hip or shoulder replacement is not exclusionary)

Current medication with coumadin or prednisone, chronic use of steroid medications, daily use of narcotic analgesics.

Burns or other acute trauma including unhealed bone fractures or open wounds.

Psychiatric illness not well controlled, or current episode of exacerbated major depressive disorder.

Any other major medical condition that has not been stabilized, or that would impair the patient's ability to complete the activities required by the study

Body Mass Index >= 40

Contacts and Locations

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To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below.
For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01322399